Single Incision Laparoscopic Combined Right Hemicolectomy and Right Renal Cryoablation

INTRODUCTION: We report the first case report of a combined approach to treat two distinct colon and renal masses through single incision laparoscopic surgery.

METHODS: A 73-year-old African American female with chronic renal insufficiency and malignant hypertension underwent single incision laparoscopic combined right hemicolectomy and right renal cryoablation for an endoscopically unresectable cecal polyp and an enlarging right renal tumor, respectively. A single 4-cm peri-umbilical incision was made and the Applied Medical GelPOINT single port device was used to insert three trocars in triangular configuration. The right colon was mobilized to expose the right renal hilum and facilitate the renal cryoablation portion of the case. The cryoablation consisted of two freeze-thaw cycles. Thereafter, the ascending colon, terminal ileum, and hepatic flexure were extracorporealized through the single port site incision to facilitate right colonic resection and anastomosis. The port site was closed in a standard fashion.

RESULTS: Both masses were successfully removed using a combined single incision laparoscopic approach without the need for conversion to open. No blood transfusions were required. Total operative time was 384 minutes. Estimated blood loss was 500-mL. No intraoperative complications occurred. The final pathologic analysis of the cecal mass confirmed the diagnosis of tubulovillous adenoma. The final pathologic diagnosis of the right renal tumor confirmed the suspicion of renal cell carcinoma and revealed membranous nephropathy. Surgical margins were widely negative and mesenteric lymph nodes harvest was sufficient. The patient reported high satisfaction at four and six months follow-up. The peri-umbilical incision healed well.

CONCLUSIONS: This combined technique is a feasible approach to manage multiple disease entities involving more than one intra-abdominal organs. To our knowledge, this is the first report of single incision laparoscopic combined right hemicolectomy and right renal cryoablation treating lesions in different intra-abdominal visceral organs.